87R20945 EAS-F
By: Price H.B. No. 1824
Substitute the following for H.B. No. 1824:
By: Klick C.S.H.B. No. 1824
A BILL TO BE ENTITLED
AN ACT
relating to the continuity of services received by individuals
receiving services at state hospitals and state supported living
centers, the establishment of a pilot program to provide behavioral
health or psychiatric services to certain residential care facility
residents, and court orders for psychoactive medication for certain
patients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 574.102, Health and Safety Code, is
amended to read as follows:
Sec. 574.102. APPLICATION OF SUBCHAPTER. (a) This
subchapter applies to the application of medication to a patient:
(1) subject to a court order for mental health
services under this chapter or other law; or
(2) transferred from a residential care facility to an
inpatient mental health facility under Section 594.032.
(b) For purposes of this subchapter, a reference to a
patient includes a person described by Subsection (a).
SECTION 2. The heading to Section 574.103, Health and
Safety Code, is amended to read as follows:
Sec. 574.103. ADMINISTRATION OF MEDICATION TO PATIENT UNDER
COURT-ORDERED MENTAL HEALTH SERVICES OR TRANSFERRED FROM A
RESIDENTIAL CARE FACILITY TO AN INPATIENT MENTAL HEALTH FACILITY.
SECTION 3. Section 574.103(b), Health and Safety Code, is
amended to read as follows:
(b) A person may not administer a psychoactive medication to
a patient under court-ordered inpatient mental health services or
to a person transferred from a residential care facility to an
inpatient mental health facility under Section 594.032 who refuses
to take the medication voluntarily unless:
(1) the patient is having a medication-related
emergency;
(2) the patient is under an order issued under Section
574.106 or 592.156 authorizing the administration of the medication
regardless of the patient's refusal; or
(3) the patient is a ward who is 18 years of age or
older and the guardian of the person of the ward consents to the
administration of psychoactive medication regardless of the ward's
expressed preferences regarding treatment with psychoactive
medication.
SECTION 4. Sections 574.104(a) and (b), Health and Safety
Code, are amended to read as follows:
(a) A physician who is treating a patient in an inpatient
setting may, on behalf of the state, file an application in a
probate court or a court with probate jurisdiction for an order to
authorize the administration of a psychoactive medication
regardless of the patient's refusal if:
(1) the physician believes that the patient lacks the
capacity to make a decision regarding the administration of the
psychoactive medication;
(2) the physician determines that the medication is
the proper course of treatment for the patient;
(3) the patient is:
(A) under an order for inpatient mental health
services under this chapter or other law;
(B) transferred from a residential care facility
to an inpatient mental health facility under Section 594.032; or
(C) the subject of a filed [an] application for
court-ordered mental health services under Section 574.034 or [,
574.0345,] 574.035 [, or 574.0355 has been filed for the patient];
and
(4) the patient, verbally or by other indication,
refuses to take the medication voluntarily.
(b) An application filed under this section must state:
(1) that the physician believes that the patient lacks
the capacity to make a decision regarding administration of the
psychoactive medication and the reasons for that belief;
(2) each medication the physician wants the court to
compel the patient to take;
(3) whether an application for court-ordered mental
health services under Section 574.034, 574.0345, 574.035, or
574.0355 has been filed;
(4) whether a court order described by Subsection
(a)(3) for [inpatient mental health] services for the patient has
been issued and, if so, under what authority it was issued;
(5) the physician's diagnosis of the patient; and
(6) the proposed method for administering the
medication and, if the method is not customary, an explanation
justifying the departure from the customary methods.
SECTION 5. Sections 574.106(a) and (a-1), Health and Safety
Code, are amended to read as follows:
(a) The court may issue an order authorizing the
administration of one or more classes of psychoactive medication to
a patient who:
(1) is described by Section 574.102(a) [under a court
order to receive inpatient mental health services]; or
(2) is in custody awaiting trial in a criminal
proceeding and was ordered to receive inpatient mental health
services in the six months preceding a hearing under this section.
(a-1) The court may issue an order under this section only
if the court finds by clear and convincing evidence after the
hearing:
(1) that the patient lacks the capacity to make a
decision regarding the administration of the proposed medication
and treatment with the proposed medication is in the best interest
of the patient; or
(2) if the patient was ordered to receive inpatient
mental health services by a criminal court with jurisdiction over
the patient, that treatment with the proposed medication is in the
best interest of the patient and either:
(A) the patient presents a danger to the patient
or others in the inpatient mental health facility in which the
patient is being treated as a result of a mental illness [disorder
or mental defect] as determined under Section 574.1065; or
(B) the patient:
(i) has remained confined in a correctional
facility, as defined by Section 1.07, Penal Code, for a period
exceeding 72 hours while awaiting transfer for competency
restoration treatment; and
(ii) presents a danger to the patient or
others in the correctional facility as a result of a mental illness
[disorder or mental defect] as determined under Section 574.1065.
SECTION 6. Section 574.107, Health and Safety Code, is
amended by amending Subsection (a) and adding Subsection (c) to
read as follows:
(a) The costs for a hearing under this subchapter for a
patient committed under this chapter shall be paid in accordance
with Sections 571.017 and 571.018.
(c) The costs for a hearing under this subchapter for a
patient committed under Chapter 593 shall be paid by the county that
ordered the commitment under that chapter.
SECTION 7. Section 574.110, Health and Safety Code, is
amended by amending Subsection (a) and adding Subsection (a-1) to
read as follows:
(a) An [Except as provided by Subsection (b), an] order
issued under Section 574.106 for a patient that is committed under
this chapter, other than a patient to whom Subsection (a-1) or (b)
applies, expires on the expiration or termination date of the order
for temporary or extended mental health services in effect when the
order for psychoactive medication is issued.
(a-1) An order issued under Section 574.106 for a patient
that is committed under Chapter 593 expires as provided by Section
592.160.
SECTION 8. Section 576.025(a), Health and Safety Code, is
amended to read as follows:
(a) A person may not administer a psychoactive medication to
a patient receiving voluntary or involuntary mental health services
who refuses the administration unless:
(1) the patient is having a medication-related
emergency;
(2) the patient is younger than 16 years of age, or the
patient is younger than 18 years of age and is a patient admitted
for voluntary mental health services under Section 572.002(3)(B),
and the patient's parent, managing conservator, or guardian
consents to the administration on behalf of the patient;
(3) the refusing patient's representative authorized
by law to consent on behalf of the patient has consented to the
administration;
(4) the administration of the medication regardless of
the patient's refusal is authorized by an order issued under
Section 574.106 or 592.156; or
(5) the administration of the medication regardless of
the patient's refusal is authorized by an order issued under
Article 46B.086, Code of Criminal Procedure.
SECTION 9. Section 592.152(a), Health and Safety Code, is
amended to read as follows:
(a) A person may not administer a psychoactive medication to
a client receiving voluntary or involuntary residential care
services who refuses the administration unless:
(1) the client is having a medication-related
emergency;
(2) the refusing client's representative authorized by
law to consent on behalf of the client has consented to the
administration;
(3) the administration of the medication regardless of
the client's refusal is authorized by an order issued under Section
574.106 or 592.156; or
(4) the administration of the medication regardless of
the client's refusal is authorized by an order issued under Article
46B.086, Code of Criminal Procedure.
SECTION 10. Section 592.153(b), Health and Safety Code, is
amended to read as follows:
(b) A person may not administer a psychoactive medication to
a client who refuses to take the medication voluntarily unless:
(1) the client is having a medication-related
emergency;
(2) the client is under an order issued under Section
574.106 or 592.156 authorizing the administration of the medication
regardless of the client's refusal; or
(3) the client is a ward who is 18 years of age or older
and the guardian of the person of the ward consents to the
administration of psychoactive medication regardless of the ward's
expressed preferences regarding treatment with psychoactive
medication.
SECTION 11. Chapter 594, Health and Safety Code, is amended
by adding Subchapter D to read as follows:
SUBCHAPTER D. TEMPORARY TRANSFER BETWEEN RESIDENTIAL CARE
FACILITIES PILOT PROGRAM
Sec. 594.101. DEFINITIONS. In this subchapter:
(1) "Alternate residential care facility" means a
residential care facility other than the one in which a resident
resides prior to a temporary transfer.
(2) "Local intellectual and developmental disability
authority" has the meaning assigned by Section 531.002.
(3) "Originating residential care facility" means the
residential care facility at which the resident resides prior to a
temporary transfer.
(4) "State supported living center" has the meaning
assigned by Section 531.002.
(5) "Temporary transfer" means the transfer of a
resident from the originating residential care facility to an
alternate residential care facility to receive behavioral health or
psychiatric services for a limited time.
Sec. 594.102. TEMPORARY TRANSFERS BETWEEN RESIDENTIAL CARE
FACILITIES PILOT PROGRAM. (a) The commission may establish a pilot
program for the purpose of providing for temporary transfers of
residents from originating residential care facilities to
alternate residential care facilities to provide behavioral health
or psychiatric services for those residents. The pilot program
must include:
(1) one alternate residential care facility for
psychiatric services; and
(2) one or two alternate residential care facilities
for intensive behavioral health services.
(b) The executive commissioner, in consultation with the
work group described by Section 594.103, by rule shall specify the
types of information the commission must collect during the pilot
program to:
(1) evaluate the outcome of the pilot program;
(2) ensure the rights of persons in the pilot program
are commensurate with the rights of persons at the originating
facility, as appropriate; and
(3) ensure services provided under the pilot program
meet the applicable requirements under Section 594.108(c)(4) and
594.109(f)(4).
Sec. 594.103. WORK GROUP MEMBERS. If a pilot program is
established under this subchapter, the executive commissioner
shall establish a work group to consult in adopting the rules
described by Section 594.102(b). The work group is composed of:
(1) two representatives who are intellectual
disability advocates, one of whom is from Disability Rights Texas;
(2) one representative from a local intellectual and
developmental disability authority;
(3) a board certified behavioral analyst with
expertise working with individuals with intellectual disabilities;
(4) a psychiatrist with expertise working with
individuals with intellectual disabilities;
(5) a psychologist with expertise working with
individuals with intellectual disabilities;
(6) a current or former resident of a state supported
living center;
(7) a family member or guardian of a current or former
resident of a state supported living center; and
(8) any other individual the executive commissioner
considers appropriate to appoint to the work group.
Sec. 594.104. TEMPORARY TRANSFER LIMITATIONS. A temporary
transfer under a pilot program established under this subchapter
may not be considered a permanent transfer and is not a discharge
from the originating residential care facility.
Sec. 594.105. TEMPORARY TRANSFER OF VOLUNTARY RESIDENT. A
voluntary resident may not be temporarily transferred to an
alternate residential care facility under a pilot program under
this subchapter without legally adequate consent to the transfer.
Sec. 594.106. RETURN OF RESIDENT. A resident shall be
returned to the originating residential care facility after
participating in a pilot program under this subchapter. The
originating residential care facility shall maintain a vacancy for
the resident while the resident participates in the pilot program.
Sec. 594.107. TRANSFER OR DISCHARGE OF RESIDENT. A
resident who is transferred to an alternate residential care
facility under a pilot program under this subchapter who no longer
requires treatment at a residential care facility may be
transferred to an alternative placement or discharged directly from
the alternate residential care facility without returning to the
originating residential care facility.
Sec. 594.108. ALTERNATE RESIDENTIAL CARE FACILITY FOR
PSYCHIATRIC SERVICES. (a) Before the temporary transfer of a
resident to an alternate psychiatric residential care unit under a
pilot program under this subchapter, the resident must be examined
by a licensed psychiatrist who indicates that the resident is
presenting with symptoms of mental illness to the extent that care,
treatment, and rehabilitation cannot be provided in the originating
residential care facility.
(b) The commission may transfer a resident under a pilot
program under this subchapter for an initial period not to exceed 60
days for the purposes of receiving psychiatric services.
(c) The alternate residential care facility for psychiatric
services operated under a pilot program under this subchapter must:
(1) use an interdisciplinary treatment team to provide
clinical treatment that is:
(A) directed toward lessening the signs and
symptoms of mental illness; and
(B) similar to the clinical treatment provided at
a state psychiatric hospital;
(2) employ or contract for the services of at least one
psychiatrist who has expertise in diagnosing and treating persons
with intellectual disabilities;
(3) employ a board certified behavioral analyst who
has expertise in diagnosing and treating persons with intellectual
disabilities;
(4) assign staff members to residents participating in
the pilot program at an average ratio not to exceed:
(A) three residents to one direct support
professional during the day and evening; and
(B) six residents to one direct support
professional over night;
(5) provide additional training to direct support
professionals working on the alternate psychiatric care unit
regarding the service delivery system for residents served on that
unit; and
(6) ensure that each psychiatric unit complies with
the requirements for ICF-IID certification under the Medicaid
program, as appropriate.
Sec. 594.109. ALTERNATE RESIDENTIAL CARE FACILITY FOR
BEHAVIORAL HEALTH SERVICES. (a) Except as provided by Subsection
(c), before the temporary transfer of a resident to an intensive
behavioral health unit under a pilot program under this subchapter,
an interdisciplinary team must determine whether the resident is an
individual who, despite an interdisciplinary team having on two or
more occasions developed or revised an interdisciplinary team
action plan in response to the occurrence of a significant event
described by Subsection (b), and appropriate treatment and
implementation of the plan, including treatment targeted to the
individual's challenging behaviors, remains likely to cause
substantial bodily injury to others and requires an intensive
behavioral health environment to continue treatment and protect
other residents or the general public.
(b) For purposes of Subsection (a), a significant event
includes:
(1) the rate of the resident's challenging behavior
has remained consistently above baseline for at least four of six
months after implementation of the interdisciplinary team action
plan; and
(2) either:
(A) the intensity of the resident's behavior has
caused serious injury to others; or
(B) the resident's physical aggression towards
others has resulted in more than three crisis restraints in the last
30 days.
(c) The associate commissioner of the commission with
responsibility for state supported living centers may make an
exception to admission criteria to require a resident to
participate in a pilot program under this subchapter. The
exception must be based on a determination that the resident's
behavior poses an imminent threat to others.
(d) In making a determination under Subsection (a), the
interdisciplinary team shall document and collect evidence
regarding the reason the resident requires an intensive behavioral
health environment to continue treatment and protect other
residents or the general public.
(e) The interdisciplinary team shall provide the team's
findings, including any documentation and evidence regarding the
proposed resident, regarding whether the proposed resident should
participate in a pilot program under this subchapter to:
(1) the associate commissioner of the commission with
responsibility for state supported living centers;
(2) the director of the state supported living center;
(3) the independent ombudsman;
(4) the resident or the resident's parent, if the
resident is a minor; and
(5) the resident's legally authorized representative.
(f) An alternate residential care facility for behavioral
health services operated under a pilot program under this
subchapter must:
(1) use an interdisciplinary treatment team that is
specially trained to provide clinical treatment designed to serve
residents who meet criteria for the pilot program;
(2) employ board certified behavioral analysts with
expertise in diagnosing and treating persons with intellectual
disabilities to provide a ratio of one analyst serving each twelve
beds full-time in accordance with commission rules providing
appropriate procedures for maintaining that ratio;
(3) employ a professional qualified to provide
counseling consistent with evidence-based, trauma-informed
treatment;
(4) assign staff members to residents participating in
the program at an average ratio not to exceed:
(A) three residents to one direct support
professional during the day and evening; and
(B) six residents to one direct support
professional at night;
(5) provide additional training to direct support
professionals working at the alternate residential care facility
regarding the service delivery system for residents served at that
facility; and
(6) ensure that the intensive behavioral health units
comply with the requirements for ICF-IID certification under the
Medicaid program, as appropriate.
(g) Except as provided by Subsection (h), a resident
transfer to an alternate residential care facility for behavioral
health services under a pilot program under this subchapter may not
exceed six months.
(h) The initial period described by Subsection (g) may be
extended by an additional, one-time period of three months if:
(1) an interdisciplinary team determines:
(A) the resident meets the standard for admission
under this section; and
(B) an extension of the initial period will
likely enable the resident to no longer meet the criteria for the
pilot program within the period of the extension; and
(2) the extension is approved by the associate
commissioner of the commission with responsibility for state
supported living centers.
(i) Except as provided by Subsection (k), if at any time
during a resident's temporary transfer to a pilot program under
this subchapter, the interdisciplinary treatment team determines
that the resident no longer requires an intensive behavioral health
environment to continue treatment and protect public safety, the
resident shall be transferred back to the originating residential
care facility not later than the seventh day after the date the
interdisciplinary team makes that determination.
(j) Except as provided by Subsection (k), at the end of the
period described by Subsection (g) or (h), as applicable, the
resident shall be returned to the originating residential care
facility not later than the seventh day after the expiration of that
period.
(k) If the associate commissioner of the commission with
responsibility for state supported living centers determines that
there are extenuating circumstances preventing the transfer within
the period described by Subsection (i) or (j), as applicable, the
associate commissioner may extend the applicable period by an
additional three days and may extend each of those additional
three-day periods by an additional three days for as long as the
occurrence of those extenuating circumstances prevent the
resident's transfer. For purposes of this subsection, "extenuating
circumstances" include extremely hazardous weather conditions or
another disaster that prevents the timely transfer of a resident.
Sec. 594.110. ADMINISTRATIVE HEARINGS. (a) A resident is
entitled to an expedited administrative hearing under Section
594.015 to challenge the resident's required participation under
Section 594.109(c) in a pilot program under this subchapter. The
hearing must be held not later than seven days after the date the
associate commissioner determines that the resident should
participate in the pilot program.
(b) A resident who is subject to a transfer decision
described by Section 594.109 is entitled to an administrative
hearing under Section 594.015. The hearing shall be limited to
determining whether the transfer decision complies with Section
594.109. A resident may waive the right to a hearing, but if a
hearing is requested the resident may not be transferred until
after the administrative hearing.
(c) A resident is entitled to an administrative hearing with
the commission to contest an extension described by Section
594.109(h).
Sec. 594.111. RIGHT TO APPEAL. An individual may appeal a
decision made at a hearing described by Section 594.110 by filing
the appeal in a district court in Travis County not later than the
30th day after the date a final order is provided to the individual.
An appeal under this section is by trial de novo.
SECTION 12. Not later than November 1, 2022, the Health and
Human Services Commission shall consult with the work group
described by Section 594.103, Health and Safety Code, as added by
this Act, and adopt any necessary rules to implement Subchapter D,
Chapter 594, Health and Safety Code, as added by this Act.
SECTION 13. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2021.